Tranexamic acid‐associated fatal status epilepticus in a paediatric non‐cardiac surgery: A case report and literature review

Aboul‐Fotouh, Sawsan; Habib, Mohamed Z.; Magdy, Sondos M; Hassan, Bahaa El-Din Ewees

doi:10.1111/bcp.15296

Cited by 5 publications

(5 citation statements)

References 62 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Although TXA is considered safe in adult populations, its safety profile in pediatric populations remains a concern, triggered by reports of seizures and life-threatening allergic reactions (29, 30). Although in this study we solely monitored for adverse events in the prehospital setting, we did not identify any record of adverse events such as seizures, anaphylaxis, or other allergic manifestations.…”

Section: Discussionmentioning

confidence: 99%

Prehospital Tranexamic Acid Administration in Pediatric Trauma Patients: A Propensity-Matched Analysis of the Israeli Defense Forces Registry

Gendler

Gelikas

Talmy

et al. 2023

Pediatric Critical Care Medicine

View full text Add to dashboard Cite

OBJECTIVES:Tranexamic acid (TXA) administration confers a survival benefit in bleeding trauma patients; however, data regarding its use in pediatric patients are limited. This study evaluates the prehospital treatment with TXA in pediatric trauma patients treated by the Israel Defense Forces Medical Corps (IDF-MC). DESIGN:Retrospective, cohort study using the Israel Defense Forces registry, 2011-2021. PATIENTS:Pediatric trauma patients less than 18 years old. We excluded patients pronounced dead at the scene. INTERVENTIONS: None.SETTING: All cases of pediatric trauma in the registry were assessed for treatment with TXA. Propensity score matching was used to assess the association between prehospital TXA administration and mortality. MEASUREMENTS AND MAIN RESULTS:Overall, 911 pediatric trauma patients were treated with TXA by the IDF-MC teams; the median (interquartile) age was 10 years (5-15 yr), and 72.8% were male. Seventy patients (7.6%) received TXA, with 52 of 70 (74%) receiving a 1,000 mg dose (range 200-1,000 mg). There were no prehospital adverse events associated with the use of TXA (upper limit of 95% CI for 0/70 is 4.3%). Compared with pediatric patients who did not receive TXA, patients receiving TXA were more likely to suffer from shock (40% vs 10.7%; p < 0.001), sustain more penetrating injuries (72.9% vs 31.7%; p < 0.001), be treated with plasma or crystalloids (62.9% vs 11.4%; p < 0.001), and undergo more lifesaving interventions (24.3% vs 6.2%; p < 0.001). The propensity score matching failed to identify an association between TXA and lesser odds of mortality, although a lack of effect (or even adverse effect) could not be excluded (non-TXA: 7.1% vs TXA: 4.3%, odds ratio = 0.584; 95% CI 0.084-3.143; p = 0.718). CONCLUSIONS:Although prehospital TXA administration in the pediatric population is feasible with adverse event rate under 5%, more research is needed to determine the appropriate approach to pediatric hemostatic resuscitation and the role of TXA in this population.

show abstract

Section: Discussionmentioning

confidence: 99%

Prehospital Tranexamic Acid Administration in Pediatric Trauma Patients: A Propensity-Matched Analysis of the Israeli Defense Forces Registry

Gendler

Gelikas

Talmy

et al. 2023

Pediatric Critical Care Medicine

View full text Add to dashboard Cite

show abstract

“…Death was reported in 10 patients, and in the remaining 11 patients, 10 required ICU admission for management of refractory convulsions and/or tachyarrhythmias 4. We have reviewed accidental intrathecal administration of TXA since 2018 and found seven additional case reports,6 8–12 including one paediatric fatal outcome 11. Death occurred in three cases, and ICU admission was necessary in the remaining four patients.…”

Section: Discussionmentioning

confidence: 99%

Polymyoclonus, ventricular fibrillation and Takotsubo after accidental spinal injection of tranexamic acid

Costa

Martins

et al. 2023

BMJ Case Rep

View full text Add to dashboard Cite

Several factors have been identified as contributing to medication administration errors, including look-alike, sound-alike (LASA) errors. LASA errors are important causes of serious adverse events arising from spinal injection of tranexamic acid, which can be confused with ampoules of local anaesthesia.We present a case of accidental injection of 250 mg of tranexamic acid rather than prilocaine during spinal anaesthesia. The patient developed lower extremities myoclonus, followed by generalised convulsions and ventricular fibrillation, that was reverted within 6 min. Severe cardiogenic shock requiring both inotropic and vasopressor therapy followed, along with a classic apical ballooning pattern on echocardiography and elevated myocardial injury markers, indicating Takotsubo cardiomyopathy. The patient’s condition progressively improved to full recovery, and she was discharged from hospital after 1 month with no neurological deficit or cardiac dysfunction.To our knowledge, this is the 28th reported case of accidental spinal injection of tranexamic acid. We present a brief review of previously published cases.

show abstract

“…Ongun et al observed seizures in two children, which is consistent with studies showing increased risk of seizure in a number of pediatric populations. 17,[35][36][37] Of note, Ongun used a protocol of 50 mg/kg TXA. In a study by Escher et al, one patient had transient neutropenia and another had intraoperative and postoperative arrhythmias; both patients received 30 mg/kg of TXA.…”

Section: High Dosementioning

confidence: 99%

Tranexamic Acid Dosing in Craniosynostosis Surgery: A Systematic Review with Meta-analysis

O’Donnell

Vazquez

Greisman

et al. 2022

Plastic and Reconstructive Surgery - Global Open

View full text Add to dashboard Cite

Objective: This study aimed to compare operative time, blood loss, and transfusion requirement in patients receiving a high tranexamic acid (TXA) dose of greater than 10 mg/kg versus those receiving a low dose of 10 mg/kg or less. Methods: PubMed, Cochrane Central, and Embase were queried to perform a systematic review with meta-analysis. Studies reporting outcomes of TXA use in craniosynostosis surgery were included. TXA dosing, operative time, blood loss, and transfusion requirement were the primary outcomes studied. Other variables studied included age and types of craniosynostosis. Results: In total, 398 individuals in the included articles received TXA for craniosynostosis surgery. TXA loading doses ranged from 10 mg/kg to 50 mg/kg. Overall, administration of TXA was not associated with changes in operative time, but was associated with decreased blood loss and transfusion requirement on meta-analysis. Comparison of high dose TXA (>10 mg/kg) versus low dose (10 mg/kg or less) showed no statistical differences in changes in operative time, blood loss, or transfusion requirement. Conclusions: Overall, TXA reduced blood loss and transfusion requirement in patients undergoing surgery for craniosynostosis. There was no difference in outcomes between high dose and low dose regimens amongst those receiving TXA. Low dose TXA appears adequate to achieve clinical efficacy with a low adverse event rate.

show abstract

Tranexamic acid‐associated fatal status epilepticus in a paediatric non‐cardiac surgery: A case report and literature review

Cited by 5 publications

References 62 publications

Prehospital Tranexamic Acid Administration in Pediatric Trauma Patients: A Propensity-Matched Analysis of the Israeli Defense Forces Registry

Prehospital Tranexamic Acid Administration in Pediatric Trauma Patients: A Propensity-Matched Analysis of the Israeli Defense Forces Registry

Polymyoclonus, ventricular fibrillation and Takotsubo after accidental spinal injection of tranexamic acid

Tranexamic Acid Dosing in Craniosynostosis Surgery: A Systematic Review with Meta-analysis

Contact Info

Product

Resources

About